Current and future advances in practice: tendinopathies of the hip.

Tendinopathy describes persistent tendon pain and loss of function related to mechanical loading. Two common hip tendinopathies seen in practice are gluteal tendinopathy and proximal hamstring tendinopathy. Both conditions can be frustrating for patients and clinicians due to the delay in diagnosis, significant disability caused and lack of response to common treatments. Tendinopathy is a clinical diagnosis and can most often be made using findings from the patient interview and pain provocation tests, without the need for imaging. Specific education and progressive exercise offer a low-risk and effective option for gluteal tendinopathy and result in greater rates of treatment success than corticosteroid injection, both in the short term (8 weeks) and at 1 year. Proximal hamstring tendinopathy is a common, but less researched, and under-recognized cause of persistent ischial pain. As research on proximal hamstring tendinopathy is limited, this review summarizes the available evidence on diagnosis and treatment following similar principles to other well-researched tendinopathies.

Equivalent contact temperature (ECT) for personal comfort assessment - analytical description and definition of comfort limits.

This paper introduces the equivalent contact temperature (ECT) model for local thermal comfort assessment in contact areas for non-uniform environmental conditions. It aims to complete the comfort evaluation scheme of the equivalent temperature approach included in ISO 14505-2 by the contact areas back and buttocks that are currently neglected in the standard. For the assessment of local and overall thermal comfort of seated persons, these contact areas are of great importance, especially if exposed to personal comfort systems. Person-oriented climatization systems, such as seat heating and ventilation, are much more energy efficient than conventional HVAC systems and allow to incorporate the human individual into the system's control loop. The ECT-approach is formally defined, analytically as well as mathematically derived and validated by a subject study. The results of the subject study (air temperature of 26 °C and 29 °C) confirm the cooling effect due to the seat ventilation and show fundamental correlations between ECTs and body part specific mean thermal votes for buttocks and back.Practitioner summary:The equivalent contact temperature model for local thermal comfort assessment in contact areas for non-uniform environmental conditions is formally defined, analytically as well as mathematically derived and validated by a subject study. It completes the existing equivalent temperature comfort scheme by both contact areas back a nd buttocks to improve thermal comfort assessment.

Outcomes in patients with burns to the perineum, buttocks and genitalia: A retrospective cohort study.

BACKGROUND: Burns that involve the perineum, buttocks and genitals (PBG) have been associated with more challenging therapeutic needs and worse clinical outcomes. We aimed to investigate whether PBG burns are an independent predictor for mortality, morbidity and complications in a large, heterogenous patient collective and in comparison to patients without PBG burns. PATIENTS AND METHODS: Patients admitted to a level one burn center between August 2014 and July 2022 were included and stratified based on the presence of PBG burns on admission (PBG & control group = CTR). Demographic baseline data, burn aetiology, inhalation trauma (IHT), full-thickness burns (FT), number of operations (NOR), mortality, length of ICU stay (LOS-ICU), length of in-hospital stay (LOHS) and bacteraemia were assessed to compare key clinical characteristics and outcomes between the groups. Multivariate regression analyses and a 1:1 propensity score matching were conducted for key clinical outcomes. RESULTS: A total of 1024 patients were included in the analysis (PBG: n = 227; CTR: n = 797). PBG burns were older (median (IQR) 54 (34-72) vs. 44, (30-61) years, p < 0.0001), more frequently female (35% vs. 23%, p = 0.002) presented with larger total body surface area (TBSA) burns overall (27 (32-39) vs. 10 (13-15) %, p < 0.0001) and sustained FT burns more frequently (69% vs. 26% p < 0.0001). Scald burns were more frequently the cause of PBG burns (45% vs. 15%, p < 0.0001), PBG patients needed twice as many surgical procedures (Mean (SD) 2 (2.84) vs. 1 (1.6), p < 0.0001) as CTR. In multivariate analyses, a significant correlation was identified between length of ICU stay and presence of PBG burns. Following strict cohort matching to account for sex, age, cause of burn, TBSA %, presence of FT burn, inhalation trauma and bacteraemia, PBG burns were an independent predictor for mortality (p = 0.0003). CONCLUSION: PBG burns are at risk for prolonged intensive care, hospitalization and complications during treatment. Furthermore, the presence of PBG burns appears to be a risk factor for mortality, irrespective of patient age, TBSA affected and other relevant covariates.

Nicolau syndrome after intramuscular injection of methocarbamol: A rare case report.

Background: Methocarbamol is a muscle relaxant medication that is commonly used to treat muscle spasms and musculoskeletal pain. Methocarbamol intramuscular injection can cause necrosis of the soft tissue. This rare condition can create severe adverse event with permanent disability. Case presentation: A 32-year-old woman with no significant past medical history presented to the emergency department with severe pain, redness, and swelling involving her left buttock and the surrounding back area. Clinical discussion: The necrotic changes due to methocarbamol intramuscular injection can progress rapidly, leading to the formation of deep ulcers, cellulitis, and even abscesses. Prompt recognition and intervention are crucial to prevent further tissue damage and complications. Conclusion: Comprehending the fundamental mechanisms and identifying risk factors related to this complication is imperative in enabling healthcare professionals to proficiently manage and avert its manifestation.

Aesthetic Ideals of the Female Buttocks: Concepts and Techniques.

This article explores the importance of understanding the tridimensional artistic anatomy of the back, pelvis, and thighs in gluteal surgery. It emphasizes the need for plastic surgeons to have a comprehensive knowledge of these anatomic structures to achieve successful outcomes. The authors highlight the significance of ethnic differences in determining ideal aesthetic results and stress the importance of considering and respecting these variations. Individualization of treatment is a key principle in gluteal surgery, as each patient has unique preferences and needs. Effective communication and collaboration between the surgeon and the patient are crucial in determining desired aesthetic goals and achieving satisfactory outcomes.

A new skin laxity scale for the buttocks: the Skin Laxity Visual Scale (SLVS).

BACKGROUND: The Skin Laxity Severity Scale for the buttocks was previously developed to separately assess buttock ptosis, a scalloped appearance of the skin, infragluteal fold, localized fat on the lower third of the buttocks, and linear depressed lesions. A more objective, faster and shorter version of this scale, to be evaluated visually, would be more feasible to apply in daily practice. OBJECTIVES: To present a new skin laxity scale for the buttocks: the Skin Laxity Visual Scale (SLVS). MATERIALS & METHODS: To establish the scale, investigators chose, by consensus, the most representative cases of each skin laxity grade. The images were graphically edited to better represent the degree of skin laxity identified in a previous study. Scale validity and reliability were assessed in two validation cycles, performed by eight dermatologists assessing 50 clinical cases. RESULTS: Overall, Kendall's, weighted-kappa, and intraclass correlation coefficients indicated very good reliability and consistent inter- and intra-rater agreement (p<0.001). The scale validity was confirmed by criteria validity tests (rs: 0.76, p<0.05). CONCLUSION: The SLVS for the buttocks is a reliable, reproducible, accurate and valid scale to identify skin laxity severity and its different features. It will very likely be an easy-to-use and convenient tool to appropriately assess improvement obtained with treatment and follow patients.

Adverse effects of dorsogluteal intramuscular injection versus ventrogluteal intramuscular injection: A systematic review and meta-analysis.

AIMS: To determine adverse effects of ventrogluteal intramuscular injections versus dorsogluteal intramuscular injections. DESIGN: A systematic review and meta-analysis. METHODS: MEDLINE, EMBASE, CINHAL, CENTRAL, LILACS(BVS), BDENF (BVS), WoS, IRCTP(WHO), ClinicalsTrials.gov and PROSPERO databases were searched with no restriction on year or language. Preferred Reporting items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. RESULTS: A total of 1429 participants from 17 studies were included. The meta-analysis found that ventrogluteal injection site had significant relation to lower pain in 9 studies (SMD = -0.63, 95% CI = -0.87, -0.39), bleeding in 4 studies (SMD = -3.46, 95% CI = -6.07, -0.86) and hematoma in 2 studies; after 48 h (SMD = -0.25, 95% CI = -0.39, -0.11), and after 72 h (SMD = -0.16, 95% CI = -0.26, -0.06), if it was compared with dorsogluteal site injection. No differences were found when comparing the possibility of intramuscular injections given into de subcutaneous tissue. In three studies, ventrogluteal site did not significantly reduce the risk of subcutaneous injection (OR 0,62, 95% CI = 0.16, 2.41).

The design of a family of parametric anatomically-based compliant buttock models to evaluate wheelchair cushion performance.

The evaluation of wheelchair cushion performance is of interest to a variety of stakeholders, including standards organizations, cushion manufacturers, clinicians, users and payers. The objective of this project was to develop a family of compliant buttock models that are based upon the anatomical parameters of persons with varying body sizes. The models are parametrically designed so can be scaled to evaluate different sized cushions. This paper will detail the designs, describe the anatomical basis for the design and provide the rationale for the design decisions. The manuscript also serves a secondary purpose to illustrate how anthropometric data can be applied to the design of anatomical phantoms that reflect both soft tissue and skeletal anthropometry. Supplemental material includes greater detail and the full CAD files and model fabrication instructions are available in an open access repository for persons who wish to fabricate the models.

Evaluation of the degree of aesthetic satisfaction after subcutaneous gluteal fat grafting / Avaliação do grau de satisfação estético após a lipoenxertia glútea subcutânea

Introduction: Body exposure, especially in the gluteal region, has increased the demand for gluteoplasty surgery. Autologous adipose tissue has been used to correct soft tissue defects since the beginning of the last century. Its smooth, natural texture, availability in sufficient quantities, and potentially permanent integration make adipose tissue the ideal physiological filler material. In this context, gluteal fat grafting, when compared with the use of gluteal implants, offers a faster recovery period and fewer complications in the medium and long term. Method: A prospective study was conducted using the gluteal evaluation questionnaire in patients who underwent subcutaneous gluteal fat grafting from August to December 2019. The collected data were submitted for statistical analysis by Student's t-test. Results: Forty patients (39 females and 1 male) who underwent subcutaneous gluteal fat grafting were selected. The average age presented in the study was 36.55 years. The mean body mass index was 27.38 kg/m2. The most frequent comorbidities were varicose veins, anemia, and hypertension. In most of the hypotheses evaluated, there was a significant improvement in the quality of life of the selected patients. Conclusions: Subcutaneous gluteal fat grafting improves patients' quality of life, which is demonstrated by the high level of satisfaction after performing this procedure.

Introdução: A exposição corporal, especialmente da região glútea, tem proporcionado atualmente um aumento da procura pela cirurgia de gluteoplastia. O tecido adiposo autólogo é usado para corrigir defeitos dos tecidos moles desde o início do século passado. Sua textura suave e natural, disponível em quantidades suficientes, e sua integração potencialmente permanente são características que fazem do tecido adiposo ser o material de preenchimento fisiológico ideal. Nesse contexto, a lipoenxertia glútea, quando comparada com o uso de implantes glúteos, oferece um período de recuperação mais rápido e menos complicações a médio e longo prazo. Método: Foi realizado um estudo prospectivo com a aplicação do questionário de avaliação dos glúteos nas pacientes submetidas a lipoenxertia glútea subcutânea no período de agosto a dezembro de 2019. Os dados coletados foram submetidos a análise estatística pelo teste t de Student. Resultados: Foram selecionados 40 pacientes (39 do sexo feminino e 1 do sexo masculino) que foram submetidos a lipoenxertia glútea subcutânea. A média da idade apresentada no estudo foi de 36,55 anos. A média do índice de massa corporal foi de 27,38 Kg/m2. As comorbidades mais frequentes foram varizes, anemia e hipertensão. Na maior parte das hipóteses avaliadas houve melhora significativa na qualidade de vida dos pacientes selecionados. Conclusões: A lipoenxertia glútea subcutânea melhora a qualidade de vida dos pacientes, o que é demonstrado pelo alto nível de satisfação após a realização desse procedimento.

Synovial sarcoma in the buttocks: an exceptional location - case report according to SCARE guidelines.

Pelvic pain is a frequent reason for consultation; the management is complex, given the differences in symptomatic and anatomical orientation. We present an exceptional case of intergluteal synovial sarcoma rarely described in the literature, with an incidence of about 1/1 000 000 and less than 10 cases of intergluteal location are published. Case Presentation: Through this publication, we present a very exceptional case of synovial sarcoma. It concerns a 44-year-old male followed for probable intergluteal lipoma for 3 months and admitted for intergluteal mass bleeding. The clinical examination revealed an intergluteal tumor mass, and the surgical resection was in favor of a synovial sarcoma.The objectives of this work are threefold: to enrich the poor literature with this new case; to underline the importance of multidisciplinary management; to recommend the obligation of anatomopathological evidence to make the diagnosis of lipoma in front of a soft tissue tumor. Discussion and Conclusion: Our case enriches the poor literature on intergluteal synovial sarcoma, where less than 10 similar reports are available. We hope through our presentation to highlight this exceptional etiology of gluteal tumor and to recall that there is no relationship between the name of this tumor and the synovium as an anatomical entity.

Misdiagnosis of food-borne foreign bodies outside of the digestive tract on magnetic resonance imaging: Two case reports.

BACKGROUND: Patients with foreign bodies in the digestive tract are often encountered, but complete penetration of a foreign body through the gastrointestinal tract is rare, and the choice of imaging method is very important. Improper selection may lead to missed diagnosis or misdiagnosis. CASE SUMMARY: An 81-year-old man was diagnosed as having a liver malignancy after he took magnetic resonance imaging and positron emission tomography/computed tomography (CT) examinations. The pain improved after the patient accepted gamma knife treatment. However, he was admitted to our hospital 2 mo later due to fever and abdominal pain. This time, he received a contrast-enhanced CT scan, which showed fish-boon-like foreign bodies in the liver with peripheral abscess formation, then he went to the superior hospital for surgery. It lasted for more than 2 mo from the onset of the disease to the surgical treatment. A 43-year-old woman with a 1 mo history of a perianal mass with no obvious pain or discomfort was diagnosed as having an anal fistula with the formation of a local small abscess cavity. Clinical perianal abscess surgery was performed, and fish bone foreign body was found in perianal soft tissue during the operation. CONCLUSION: For patients with pain symptoms, the possibility of foreign body perforation should be considered. Magnetic resonance imaging is not comprehensive and that a plain computed tomography scan of the pain area is necessary.

What Makes a Beautiful Buttock Beautiful? A Case-Control Study Comparing Buttocks Models versus Normal Women by Magnetic Resonance Imaging, Photography and Anthropometry.

OBJECTIVES: To describe characteristics of women with aesthetically ideal buttocks and differentiate them from women with normal buttocks. METHODS: Case-control study comparing anatomy of women with ideal buttocks (buttocks models) to women with normal buttocks using magnetic resonance images, anthropometric measurements and photography. RESULTS: Comparing to normal women, buttocks models have a narrower waist, narrower iliac crest, wider C point, wider hips and bigger and thicker gluteus maximus muscle (GMM). A bigger GMM adds more projection to the C point, point of maximum projection in the lateral view is 2.7 cm higher than the pubic bone. The amount of subcutaneous fat was equal in models and controls. CONCLUSIONS: Our study provides new knowledge regarding the tridimensional aspects of the beauty of the buttocks area. A beautiful buttock is a conjunction of adequate bony shape, muscle development, subcutaneous fat layer, and tight skin. Comparing to normal women, buttocks models have a narrower waist, narrower iliac crest, wider C point, wider hips and bigger and thicker Gluteus Maximus Muscle. Accurate understanding of the aesthetic goals in a given patient can guide surgical technique. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Treatment of bruising after injection to reduce cellulite.

BACKGROUND: Cellulite 80%-98% of post-pubertal women and results in cutaneous dimples in the affected area. AIMS: Therapies that target collagenous fibrous septae often provide successful outcomes. MATERIALS & METHODS: Collagenase clostridium histolyticum-aaes (CCH) for injection consists of two collagenases which, under physiologic conditions, disrupt collagen structures by hydrolyzing Type I and III collagen. RESULTS: Subcutaneous CCH was approved in the United States in 2020 for the treatment of moderate-to-severe cellulite in the buttocks of adult women. Although bruising is primarily an aesthetic concern, a conspicuous procedure-induced bruise may limit a patient's social activities and result in hesitation to undergo a similar cosmetic procedure in the future. CONCLUSION: The purpose of this review is to describe the available techniques for hastening bruise resolution and how they apply to resolving bruises associated with a CCH injectable.

When "the runs" also burns: Case reports of severe diaper dermatitis in children with acute gastroenteritis mimicking scald burns.

Burns to the buttocks of a child are highly concerning for child abuse unless there is a clear history to support an alternative diagnosis. We report two cases of severe erosive diaper dermatitis presenting as buttocks and perineal burns caused by prolonged exposure to diarrheal stool. These cases underscore the importance of making the right diagnosis to avoid the undue psychosocial stress to families that comes with a mistaken diagnosis of inflicted injury, and further add to our understanding of diarrheal contact burns in the absence of laxative use.

Penetrating buttock trauma is morbid but rarely fatal - A South African experience.

BACKGROUND: Penetrating injuries to the buttock are relatively rare but are associated with significant morbidity. This study aimed to review our experience in managing penetrating trauma to the buttocks to contextualize the injury, document the most common associated injuries, and generate an algorithm to assist with the management of these patients. METHODS: A retrospective study was conducted at a major trauma center in South Africa over 8 years (January 2012 to January 2020). All patients presenting with a penetrating buttock injury were included. RESULTS: Our study included 40 patients. Gunshot wounds accounted for 93% (37/40), stab wounds accounted for 5% (2/40), and 1 case was gored by a cow. The majority (98%) underwent further investigation in the form of imaging or endoscopy. Forty percent (16/40) required surgical intervention. Of these 16 cases, 14 required a laparotomy, and 2 required gluteal exploration. Fifty-six percent (9/16) required a stoma. Five percent (2/40) experienced one or more complications, both of whom had stomas. The median length of stay for all patients was 3 days, whereas for the patients with stomas was 7 days. There were no ICU admissions or mortality in this study. Only 3 of the 9 stomas were reversed, and the median time to reversal was 16 months. CONCLUSION: Penetrating trauma to the buttock may result in injuries to surrounding vital structures, which must be actively excluded. Rectal injury was the most common injury, and most required a defunctioning colostomy as part of the management resulting in significant morbidity.

Surgical removal of Aquafilling localized to different sites.

<b><br>Introduction:</b> Aquafilling, a widely used soft-tissue filler since 2005, shows multiple adverse effects, necessitating the development of effective methods for its removal. We present a surgical method for removal of Aquafilling present in the breasts, breasts with migration to the chest and/or the abdomen, and the buttocks, and elaborate and discuss the advantages of this method.</br> <b><br>Aim:</b> The aim of this study was to present a surgical method for removal of Aquafilling (soft-tissue filler) present in the breasts, breasts with migration to the chest and/or the abdomen, and the buttocks, and to elaborate the advantages of this proposed technique.</br> <b><br>Materials and methods:</b> The surgical Aquafilling removal method described here was used in 25 patients (age, 21-53 years). The technique was used to remove Aquafilling present in the breasts (14 patients), breasts with migration to the chest and/or the abdomen (7 patients), and the buttocks (3 patients). The detailed course of Aquafilling removal surgery and postoperative treatment for these three types of cases is described.</br> <b><br>Results:</b> Surgical removal of Aquafilling with the described method did not cause any of the previously described ailments in each patient, excluding one patient who only showed significant pain reduction in both breasts preceding each menstruation cycle.</br> <b><br>Conclusions:</b> The method described herein can be recommended for removal of Aquafilling present in the breasts, breasts with migration to the chest and/or the abdomen, and buttocks, since it allowed thorough Aquafilling removal and decreased the local inflammatory state and the risk of potential carcinogenesis.</br>.

Interethnic Influencing Factors Regarding Buttocks Body Image in Women from Nigeria, Germany, USA and Japan.

BACKGROUND: Body image research deals a lot with awareness of the body as an entity. Studies that consider individual anatomical aspects and place them in an intercultural context are rarely present. METHODS: For this purpose, general data, body perception and judgment of body images from 2163 (48% female and 52% male) participants from Germany, Nigeria, the USA and Japan were evaluated as part of a survey. RESULTS: There were clear differences in the personal body image of the participants' own buttocks, the buttocks as a beauty ideal and the way in which dissatisfaction was dealt with in different countries. In addition to sexual well-being (importance score: 0.405 a.u.), the country of origin (0.353), media consumption (0.042) and one's own weight (0.069) were also identified as influencing factors for satisfaction with one's own buttocks. A clear evolution could be derived regarding a WHR (waist-to-hip ratio) of well below 0.7, which was consistently favored by the participants but also propagated by influencers through images (p < 0.001). In this context, participants who indicated celebrities as role models for the buttocks showed a correspondingly high level of dissatisfaction with their own buttocks (R = -0.207, p < 0.001, ρ = -0.218). CONCLUSION: Overall, a highly significant correlation was shown between the consumption frequency of Instagram, TikTok and pornography with the negative perception of women's own buttocks.

No Difference in Hip Muscle Volumes and Fatty Infiltration in Those With Hip-Related Pain Compared to Controls.

Background: Little is known about muscle morphology in people with hip-related pain, without signs of femoro-acetabular impingement syndrome (FAIS). Identifying changes in hip muscle volume, fatty infiltrate and establishing relationships between muscle volume and strength, may provide insight into potential early treatment strategies. Purposes: To: (i) compare the volumes and fatty infiltrate of gluteus maximus, gluteus medius, gluteus minimis, tensor fascia latae and quadratus femoris between symptomatic and less-symptomatic sides of participants with hip-related pain; (ii) compare the volumes and fatty infiltrate of hip muscles between healthy controls and symptomatic participants; and (iii) explore relationships of hip muscle volumes to muscle strength and patient-reported outcome measures in people with hip-related pain. Study Design: Cross-sectional study. Methods: Muscle volume and fatty infiltrate (from magnetic resonance imaging), hip muscle strength, patient-reported symptoms, function and quality of life (QOL) were determined for 16 participants with hip-related pain (no clinical signs of FAIS; 37±9 years) and 15 controls (31±9 years). Using One Way Analysis of Co-Variance tests, muscle volume and fatty infiltrate was compared between the symptomatic and less-symptomatic sides in participants with hip-related pain as well as between healthy controls and symptomatic participants. In addition, hip muscle volume was correlated with hip muscle strength, hip-reported symptoms, function and QOL. Results: No differences in all the studied muscle volumes or fatty infiltrate were identified between the symptomatic and less-symptomatic hips of people with hip-related pain; or between people with and without hip-related pain. Greater GMED volume on the symptomatic side was associated with less symptoms and better function and QOL (ρ=0.522-0.617) for those with hip-related pain. Larger GMAX volume was associated with greater hip abduction and internal rotation strength, larger GMED volume was associated with greater hip extension strength, and larger QF volume was associated with greater hip abduction strength (rho=0.507-0.638). Conclusion: People with hip-related pain and no clinical signs of FAIS have hip muscle volumes that are not significantly different than those of matched pain-free controls or their less-symptomatic hip. Larger GMED muscle volume was associated with fewer symptoms and greater strength. Level of evidence: Level 3a.